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Home My WebLink About2016-121 Ambulance Operators License 4 CE T Y F ASHLAND ( j Ambulance Operator's License License issued to: 11 s City of Ashland Fire and Rescue Department b i y r,1 l 01 has met all requirements of AMC Chapter 6.40 - License expires June 30, 2017 ~~11 r f Date Barbara Christensen, City Recorder/Treasurer • _ " ~-fir ~ ~ i i . i M I~ uI ~i CITY OF ASHLAND Council Communication 05117/2016, Business Meeting Ambulance Operator's License Renewal FROM: John Karns, Fire Chief, Ashland Fire & Rescue tram j'i -ashiand.o .Rus SUMMARY The Ashland Municipal Code requires that all ambulance service providers in the City obtain an ambulance operator's license. This is the Fire Department's request for the renewal by Council of the Fire Department's Ambulance Operator's License per AMC 6.40.110. BACKGROUND AND POLICY IMPLICATIONS: Ashland Municipal Code (AMC) Chapter 6.40.110 requires ambulance service providers operating within the City of Ashland to apply annually for an ambulance operator's license. The Fire Department has provided emergency services in Ashland since 1885. From 1926 to 1936, the fire department operated the ambulance service in Ashland, and in 1936 the ambulance service was sold to Litwiller Funeral Home. The fire department obtained its first medical response vehicle (Rescue 9) through community donations in 1973, and began providing first response emergency medical services to the community. In January 1996, the City of Ashland purchased the Ashland Life Support Ambulance Company and Ashland Fire & Rescue began providing ambulance services within a 650 sq mile ambulance service area in south Jackson County, known as ASA III. Ambulance services in Oregon are regulated by county governments, and within the City of Ashland they are required to obtain an ambulance operator's license. This license is renewed on an annual basis. FISCAL IMPLICATIONS: The license fee is $300 plus $100 per ambulance, for a total of $800. This is provided for by a line item in the department's emergency medical services budget (604160). STAFF RECOMMENDATION AND REQUESTED ACTION: Staff recommends renewal of the Ambulance Operator's License for Ashland Fire & Rescue. SUGGESTED MOTION: I move approval of the application for an Ambulance Operator's License for Ashland Fire & Rescue. ATTACHMENTS: Ambulance license renewal application. Page 1 of 1 Irr PIA Ashland Fire & Rescue Ashla ,r', OR SW LA This report was generated on 5/10/2016 4:22:48 PM State IDs per Personnel ID _ NAME 3 STATE EMS ID EMS CERT LEVEL _STATE TRAINING ID 1144 Beck [P], Todd 124333 EMT Paramedic 9119 089170 Boyersmith [P], Steve 120378 EMT Paramedic 5901 089667 Burns [P], Andrew 139879 EMT Paramedic 27749 9472 Bums [P], Kelly 120248 EMT Paramedic 12147 089437 Foss [P], Justin 131705 EMT Paramedic 20624 25664 Freiheit [P], Matt 121237 EMT Paramedic 9854 089466 Garfas-Knowles [P], Ron 132871 EMT Paramedic 25087 1126 Hadden [P], Jennifer 124336 EMT Paramedic 13281 33984 Hanstein [P], David 111814 EMT Paramedic 7088 089515 Hegdahl [P], Tim 135298 EMT Paramedic 25030 089289 Hickman [EMT], Margueritte 128$89 EMT 13324 36864 Hollingsworth [P], Scott 113607 EMT Paramedic 3629 089399 Knutson [P], Brent 130961 EMT Paramedic 19472 089163 Lacoste [P], Rod 127119 EMT Paramedic 13893 089465 Manning [P], Ashley 132690 EMT Paramedic 22552 089625 Mekkers [P], Mike 135069 EMT Paramedic 5585 089277 Menold [P], Lance 125954 EMT Paramedic 17566 089565 Palmesano [P], Nick 134776 EMT Paramedic 25485 089255 Rasor [P], Marshall 126969 EMT Paramedic 13980 089436 Roselip [P], David 130561 EMT Paramedic 17793 69056 Rosenlund [P], Derek 121067 EMT Paramedic 12485 089666 Safko [P], Kyle 143902 EMT Paramedic 31523 69248 Sallee [P], Dana 116336 EMT Paramedic 12486 1052 Shepherd [P], David 123197 EMT Paramedic 9766 1053 Stephens [P], Robert 123787 EMT Paramedic 12148 77560 Stoy [P], Trent 118911 EMT Paramedic 12483 089295 Stubbs [P], Todd 130277 EMT Paramedic 16319 089665 Thomason [P], Jim 139172 EMT Paramedic 28470 089428 Trask [P], Robert 130008 EMT Paramedic 16743 089394 Turner [P], Shannon 126208 EMT Paramedic 12628 089630 Winwood [P], Brandon 136263 EMT Paramedic 25223 emergencyreporting. com Doc Id: 1255 All active personnel Page # 1 CITY OF ASHLAND APPLICATION FOR AMBULANCE OPERATOR LICENSE AMC Ch. 6. 6.40 2016 Applicant's Name: CITY OF ASHLAND Trade Name, if any: ASHLAND FIRE & RESCUE Address: 455 Siskiyou Boulevard Ashland OR 97520 Telephone number: (541) 482-2770 Ambulance descriptions Manufacturer Vin # License # 1. 2002 Ford LIFELINE 1 FDXF47F63EA10341 EXEMPT 2. 2016 Ford NORTON 1 FDUF4HTXGEA67381 EXEMPT 3. 2011 Ford LIFELINE 1 FDUF4HTOBEC53861 EXEMPT 4. 2006 FORD LIFELINE 1 FDXF47F06ED06467 EXEMPT 5. 2008 FORD LIFELINE 1 FDXF47R48ED90832 EXEMPT ❑ Attach information showing that every proposed driver, attendant and driver- attendant is qualified as required in Ashland Municipal Code Chapter 6.40 and as required by the laws of the State of Oregon. ❑ Enclose with the application, the initial license fee of $300 plus $100 per ambulance. ❑ Enclose a performance bond in the amount of $500,000. ❑ Enclose an insurance policy meeting the requirements of AMC §6.40.110.7. Attach additional pages as necessary. Explain any box not checked. Submit your application and required enclosures to Barbara Christensen, City Recorder, City Hall, 20 East Main Street, Ashland, Oregon 97520. 1 certify that each ambulance listed above is adequate and safe for the purposes for which it is to be used and that it is equipped as required by Ashland Municipal Code Chapter 6.40 and the laws of the State of Oregon. Signature Print name: Kimberley Summers Title: Administrative Assistant Date: 05-17-2016 H:1Ambulance License Fee12015 Lic. renewal.doc April 10, 2009 ROSTYKUS, PAUL S MD ASHLAND FIRE DEPARTMENT g MED DIRECTOR: DR PAUL ROSTYKUS N 455 SISKIYOU BLVD ASHLAND, OR 97520-0000-000 • g ~ w IIIIIIIIIIIIIIIIIIIfIII111II11fII1F1II111II111II111II111II111 • cn J DEA REGISTRATION THIS REGISTRATION FEZ= I CONTROLLED SUBSTANCE REGISTRATION CERTIFICATE NUMBER EXPIRES PAID I UNITED STATES DEPARTMENT OF JUSTICE BA3050692 04-30-2018 FEE EXEMPT I DRUG ENFORCEMENT ADMINISTRATION WASHINGTON D.C. 20537 SCHEDULES BUSINESS ACTIVITY ISSUE DATE Restricted to Government personnel for official duties only. 2,2N, PRACTITIONER 03-19-2015 1 3,3N,4;5, I ROSTYKUS, PAUL S MD I Sections 304 and 1008 (21 USC 824 and 958) of the Controlled LIMITED TO OFFICIAL GOVERNMENT DUTIES ONLY I Substances Act of 1970, as amended, provide that the Attorney ASHLAND FIRE DEPARTMENT I General may revoke or suspend a registration to manufacture, distribute, dispense, import or export a controlled substance. 455 SISKIYOU BLVD I ASHLAND, OR 97520-0000 I THIS CERTIFICATE IS NOT TRANSFERABLE ON CHANGE OF OWNERSHIP, CONTROL, LOCATION, OR BUSINESS ACTIVITY, I AND IT IS NOT VALID AFTER THE EXPIRATION DATE. CONTROLLED SUBSTANCE REGISTRATION CERTIFICATE UNITED STATES DEPARTMENT OF JUSTICE DRUG ENFORCEMENT ADMINISTRATION WASHINGTON D.C. 20537 DEA REGISTRATION THIS REGISTRATION FEE NUMBER EXPIRES PAID BA3050692 04-30-2018 FEE EXEMPT Restricted to Government personnel for official duties only. SCHEDULES BUSINESSACTIVITY ISSUE DATE 2,2N, PRACTITIONER 03-19-2015 3,3N,4,5, o ROSTYKUS, PAUL S MD `r LIMITED TO OFFICIAL GOVERNMENT DUTIES ONLY Sections 304 and 1008 (21 USC 824 and 958) of the Controlled Substances. Act of 1970, as amended, N ASHLAND FIRE DEPARTMENT provide that the Attomey General may revoke or 455 SISKIYOU BLVD suspend a registration to manufacture, distribute, o ASHLAND, OR 97520-0000 dispense, impart or export a controlled substance. 0 THIS CERTIFICATE IS NOT TRANSFERABLE ON CHANGE OF OWNERSHIP, CONTROL, LOCATION, OR BUSINESS ACTIVITY, AND IT IS NOT VALID AFTER THE EXPIRATION DATE. DEA REGISTRATION THIS REGISTRATION FEE CONTROLLED SUBSTANCEIREGULATED CHEMICAL NUMBER EXPIRES PAID REGISTRATION CERTIFICATE BA3050692 04-30-2018 FEE EXEMPT UNITED STATES DEPARTMENT OF JUSTICE DRUG ENFORCEMENT ADMINISTRATION SCHEDULES BUSINESS ACTIVITY ISSUE DATE WASHINGTON D.C. 20537 2,2N, PRACTITIONER 03-19-2015 Restricted to Government personnel for official duties only. 3 3 N 4 5 Sections 304 and 1008 (21 USC 824 and 958) of the ROSTYKUS, PAUL S MD Controlled Substances Act of 1970, as amended, provide LIMITED TO OFFICIAL GOVERNMENT DUTIES ONLY that the Attorney General may revoke or suspend a ASHLAND FIRE DEPARTMENT registration to manufacture, distribute, dispense, import or 55 SISKIYOU BLVD export a controlled substance. SHLAND, OR 97520-0000 THIS CERTIFICATE IS NOT TRANSFERABLE ON CHANGE OF OWNERSHIP, CONTROL., LOCATION, OR BUSINESS ACTIVITY, AND IT IS NOT VALID AFTER THE EXPIRATION DATE, i I REQUESTING MODIFICATIONS TO YOUR REGISTRATION CERTIFICATE s i To request a change to your registered name, address, the drug REPORT I schedule or the drug codes you handle, please iZ- o I CHANGES 1. visit our web site at deadiversion.usdoj.gov - or 2. call our customer Servioe Center at 1-(800) 882-9539 - or Cl) `I 3, submit your change(s) in writing to: I Drug Enforcement Administration PROMPTLY I P.O. Box 28083 I Washington, DC 20083 i I See Title 21 Code of Federal Regulations, Section 1301.51 u_ I for complete instructions. You have been registered to handle the following chemicaUdrug codes_------- CERTIFICATE OF COVERAGE Agent This certificate is issued as a matter of information only and confers no rights upon the certificate holder other DIRECT than those provided in the coverage document. This certificate does not amend, extend or alter the coverage afforded by the coverage documents listed herein. citycounty insurance services Named Member or Participant Companies Affording Coverage City of Ashland COMPANY A - CIS 20 East Main Street COMPANY B - National Union Fire Insurance Company of Pitts, PA Ashland, OR 97520 COMPANY C - RSUI Indemnity LINES OF COVERAGE This is to certify that coverage documents listed herein have been issued to the Named Member herein for the Coverage period indicated. Notwithstanding any requirement, term or condition of any contract or other document with respect to which the certificate may be issued or may pertain, the coverage afforded by the coverage documents listed herein is subject to all the terms, conditions and exclusions of such coverage documents- Type of Coverage Company Certificate Effective Termination Date Coverage Limit Letter Number Date General Liability A 14LASH 7/1/2014 711/2015 General Aggregate: $15,000,000 X Commercial General Liability Each Occurrence: $5,000,000 X Public Officials Liability X Employment Practices X Occurrence Auto Liability A 14LASH 7!1/2014 7/112015 General Aggregate: None X Scheduled Autos Each Occurrence: $5,000,000 X Hired Autos X Non-Owned Autos Auto Physical Damage A 14APDASH 71112014 7/112015 X Scheduled Autos X Hired Autos X Non-Owned Autos X Property A/C 14PASH 71112014 7/1/2015 Per Filed Values X Boiler and Machinery A 14BASH 7/1/2014 71112015 Per Filed Values X Excess Crime B 14ECASH 71112014 71112015 Per Loss: $250,000 Excess Earthquake Excess Flood Excess Cyber Liability Workers' Compensation Description: Jackson County is named as additional insured per the agreement made between Jackson County and the City of Ashland giving Ashland Fire & Rescue the exclusive right to provide ambulance service in ASA #3. Certificate Holder. CANCELLATION: Should any of the coverage documents herein be cancelled before the expiration date Jackson County thereof, CIS will provide 30 days written notice to the certificate holder named herein, but failure to mail 1005 East Main Street such notice shall impose no obligation or liability of any kind upon CIS, its agents or representatives, or the Medford, OR 97504 issuer of this certificate. Date: August 25, 2014 ORE60N HEALTH AOTH'RITY AuDiTtvo. P08L.fC HEALTH DivisiON - 60906 EMERGENCY MEDICAL SERVICES 8c TRAUMA SYSTEMS PROGARM AGENCY NUMBER: 1501 OPERATION DATES - - MO. DAY Y?- THRU MO.`DAY YR. < t35365~2Q'15 06/3012016 STATE EMS OFFICE COPY City of.Ashland #1501 455 Siskf.k 131vd Ashland- OR 97520 PRYMENTDATE MO. DAY YR. 05/05/20-15 CITY OF ASHLAND May 27, 2015 Director Mark Orndoff, Jackson County Health & Human Services 1005 E. Main Street Medford, Oregon 97504 Dear Director Orndoff, Please accept this letter as evidence of Ashland Fire & Rescue's intent to reapply for assignment of Jackson County Ambulance Service Area 43 pursuant to Jackson County Ordinance Chapter 1075, Exhibit A. Five year assignment per Section 7.3 A. Reassignment of Ambulance Service Area 3 (South County-Ashland/Talent) to Ashland Fire & Rescue will serve to ensure the continued integration of emergency medical services within Jackson County. Since 1996, Ashland Fire & Rescue has been providing high quality ambulance services to the resident of south Jackson County as the primary ambulance services provider. We continue to receive above average approval ratings from our patients regarding the ambulance services provided, as evidenced by their many notes, letters and e-mail comments to both the Fire Department and our billing service. In addition to receiving high approval ratings from our patients, we enjoy a strong cooperative working relationship with all other EMS providers within the county, and also with adjacent service providers outside of Jackson County. Ashland Fire & Rescue has consistently operated well within all Jackson County ASA response time standards, and met or exceeded all other standards and requirements of our ASA agreement. We continue to be a major participant in decisions and activities directed toward the ongoing improvement of county-wide EMS services, andwe have faithfully executed our assigned stewardships within the EMS community. We are looking forward to the potential renewal of our ASA service contract with Jackson County and the continued and uninterrupted provision of quality ambulance services to the citizens of south Jackson County. Respectfully, John Karns Fire Chief ASHLAND FIRE & RESCUE 455 Siskiyou Boulevard Ashland, OR 97520 ~r (541) 482-2770 • Fax (541) 488-5318 M: 800-735-2900 PRINTED ON RECYCLED PAPER City :,r Ashland, Oregon - Municipal Code http://www.ashland.or.us/CodePrint.asp?CodefD=2353 h L'~ ~Ial w A. Any person desiring to obtain an ambulance operator license shall apply upon forms available from the city recorder. Each application shall be accompanied by a surety bond in the amount provided in this chapter. The application shall include the following information: 1. The name of the applicant and trade name, if any, under which the applicant intends to conduct the business; or if it is a corporation, its name, date and place of incorporation, address of its principal place of business and the names of its principal officers, together with their respective residence addresses; or if a partnership, association or unincorporated company, the names of the partners, or of the persons comprising such association or company, and the business and residence address of each partner or person. 2_ A description of each ambulance or other vehicle used, or proposed to be used, by the applicant, with the name of the manufacturer, engine and serial numbers, state motor vehicle license number, together with a certification that each ambulance is adequate and safe for the purposes for which it is to be used and that it is equipped as required by this chapter and the laws of the state of Oregon. 3. The address and description of the premises at and from which it is proposed to maintain and operate such ambulances. 4. Information showing that every proposed driver, attendant, and driver-attendant is qualified as required in this chapter and as required by the laws of the state of Oregon. 5. The applicant shall furnish such additional information as the city may require. 6. Upon application for an ambulance operator's license, applicant shall furnish the city with a good and sufficient cash bond or surety bond in the sum of $500,000.00 which shall be continued in effect during the period that such ambulance operator shall do business in the city. The bond shall be given as a guarantee that the ambulance operator will furnish and maintain ambulance service from the date of obtaining a city license without interruption of service, except that by giving 180 days' notice to the city, such ambulance operator shall be authorized to discontinue service without penalty. If, for any reason, the licensed ambulance operator shall cease operations or discontinue business for any reason whatsoever, voluntarily or involuntarily, without giving the notice herein required, such cash bond or surety bond shall be forfeited to the city. 7. No ambulance operator's license shall be issued unless there is also on file with the city an insurance policy approved by the city administrator, whereby the owner and driver of each of the vehicles described in this license are insured against liability for damage to property and for injury to, or death of, any person resulting from the ownership, operation, or other use thereof. This policy shall be in the sum of not less 1 of 2 5/10/2016 4:02 PM Ciq' ci AsWand, Oregon - Municipal Code http://www.ashland.onus/CodePrint_asp?CodeID=2353 than $500,000.00 for property damages, personal injuries to, or death of persons in any single accident. a. The insurance policy shall contain an endorsement providing that this policy of insurance will not be canceled until notice in writing shall have been received by the city administrator at least thirty days prior to the time such cancellation shall become effective. b. The insurance policy must be issued by a company authorized to do business in the State of Oregon. This policy shall further provide that there shall be a continuing liability thereon, notwithstanding any recovery on this policy. If, at any time, this insurance policy shall be canceled by the company issuing the same, or the authority of the company to do business in the state of Oregon shall be revoked, the certificate holder shall replace the policy with another policy approved by the city administrator. B. The initial license fee and each yearly renewal thereafter shall be $300 for an Ambulance Operator's License plus $100 per ambulance providing emergency medical services to the city. Changes in the amount of these fees may be made by resolution of the council. 3 PRINT CLOSE 2 of 2 5/10/2016 4:02 PM CITY OF ASHLAND Memo DATE: May 10, 2016 TO: Lee Tuneberg Cindy Hanks FROM: Kimberley Summers RE: Renewal of City of Ashland Ambulance Operators License Fee Lee, Our ambulance license is due to expire on June 30, 2016 and we need to renew our ambulance operator's license for July 1, 2016 to June 30, 2017. Would you please do an inner-departmental transfer or check for the ambulance licensing fees in the amount of $800.00. It will need to be transferred from EMS account 4 110.07.13.00.604160 and put into the City of Ashland Accounts Receivable. This will need to be included in the renewal application for ambulance operator's license that includes the required certifications and documentation required by the AMC 6.40 a memo will be sent to Dave Kanner and a Council Communications requesting ambulance license renewal. I have contacted Diana Shiplet to have this placed on the next council meetings consent items agenda. As in the past the fees and bond have just been charged to our budget please let me know if this is still the correct procedure. I would like to know if we can streamline the process to obtain our annual business license. Thank you for your time Kimberley Summers 1 OREGON HEALTH AUTHORITY AUDIT NO. PUBLIC HEALTH DIVISION EMERGENCY MEDICAL SERVICES & TRAUMA SYSTEMS PROGARM AGENCY NUMBER: OPERATION DATES MO. DAY YR. THRU MO. DAY YR. 1501 05/1212016 6/30/2017 AMBULANCE AGENCY LICENSE - POST IN AGENCY City of Ashland #1501 PAYMENT DATE 455 Siskiyou Blvd MO. DAY YR. Ashland, OR 97520 05112/2016 MUST BE POSTED IN A CONSPICUOUS PLACE - NOT TRANSFERABLE